WFP SUPPLIER REGISTRATION FORM
Section 1: Company Details and General Information
1. Name of Company/Institution (full legal name):
2. Street Address: 3. P.O. Box and Mailing Address:
Postal Code: City:
Country:
4. Tel (include country and area codes): 5. Fax (include country and area codes):
6. Email: 7. WWW Address:
8. Contact Name and Title:
9. Ownership and Parent Company (full legal name):
10. Name and Address of Subsidiaries, Associates and/or Overseas Representative(s) (attach a separate sheet if necessary):
11a. Nature of Business (please tick one box in each section):
Manufacturer: Trader: Authorised .Agent: Consulting Company: Other (specify):
11b.Type of Business
Corporate/Limited: Partnership: Gov. Agency: University: Other (specify):
12. Year Established (under the name shown in 1): 13. Number of Full-time Employees:
14. Licence N/State Where Registered: 15. VAT N/Tax ID:
16. Technical Documents Available in:
English French Spanish Russian Arabic Chinese Other (specify)
17. Working Languages:
English French Spanish Russian Arabic Chinese Other (specify)
Section 2: Financial Information
18. Annual Value of Total Income for the Last 3 Financial Years:
Year ______: USD ___________ million Year ______: USD ___________ million Year ______: USD ___________ million
19. Annual Value of Export Sales for the last 3 Financial Years:
Year ______: USD ___________ million Year ______: USD ___________ million Year ______: USD ___________ million
20. Bank Name: Swift/BIC Address:
Address:
21. Bank Account N: Account Name:
22. Please provide a copy of the company's annual or audited financial report of the last 3 years.
If available, please provide credit rating by Dun and Bradstreet or equivalent (specify which).
Section 3: Technical Capability and Information on Goods / Services Offered
23. If available, Quality Assurance Certification, e.g. ISO 9000 or National Standard. Provide a copy of your latest certificate.
24. International Offices/Representation (countries where the company has local offices/representation):
25. List below up to 15 of your core goods /services offered with their respective UNCCS codes. The codes can be found in the UNCCS thesaurus.
Please note that to we are unable to code your goods/services for you. However if you have difficulties in selecting an appropriate code, please
contact the UNCSD Secretariat for assistance.
UNCSD Secretariat, Øvre Slottsgate 2b, N-0157 Oslo, Norway
Tel: +47 22 24 62 92 Fax: +47-22 24 62 81 Email: registry@uncsd.org WWW Address: http://www.uncsd.org
UNCCS Code UNCCS Description (one line for each item) National/International Quality Standard
to which Item conforms
Section 4: Experience
26. Recent contracts with the UN (see Note1) and/or other international aid organisations (attach a separate sheet if necessary). Please provide
documentary evidence of such contracts is required, e.g. copies of purchase orders.
Organisation Value Year Goods/Services Supplied Destination Country
USD
USD
USD
USD
USD
27. To which countries has your company exported and/or managed projects over the last 3 years? Please list export markets, in particular
development countries.
Section 5: Other
28. Does your company have a written statement of its environmental policy (see Note2) ? If yes, please provide a copy. Yes No
29. Is your company Electronic Data Interchange enabled? Yes No
30. Please list any disputes your company has been involved in with UN Organisations over the last 3 years:
31. List any national or international trade or professional Organisations of which your company is a member:
32. Certification:
I, the undersigned, warrant that the information provided in this form is correct, and in the event of changes details will be provided as soon as
possible.
Name Functional Title
Signature Date
The legal agreement between the supplier and the organisation within the UN System shall be defined in the purchase
order/contract and any associated contract(s) between the supplier and the UN organisation. Information provided to
the supplier in association with the registration is provided for reference only, and in no case shall take precedence over
terms in the purchase order/contract or the associated contract(s).
Please be informed that WFP has decided not to do business with companies or any of their affiliates or subsidiaries,
which engage in any practice inconsistent with the rights set forth in the convention on the Rights of the Child,
regarding certain protection applicable to children performing work, or engage in the sale or manufacture of anti-
personnel mines, or any significant component produced primarily for the operation thereof.
Note 1: Organisations in the UN system are UN; UNCTAD; UNEP; UNCHS(Habitat); UNICEF; UNDP; WFP; UNHCR; UNRWA; UNFPA; UNOPS;
UNU; ILO; FAO; UNESCO; ICAO; WHO; WB; IMF; UPU; ITU; WMO; IMO; WTO; WIPO; IAPSO; IFAD; UNIDO; IAEA; ITC; ECA; ECE; ECLAC;
ESCAP; ESCWA.
Note 2: The Earth Summit, held in Rio de Janeiro in 1992, emphasised the necessity to protect and renew the earth's limited resources. Agenda 21 was
adopted by 178 governments and lays an emphasis for the UN to exercise leadership, i.e. towards promoting environmental sensitive procurement
policies for goods and services.
Please return completed form to:
